PSYX 340 Psychological Disorders · Unit 2: Mood, suicide, body and addiction · on Exam 2
2.4 Disorders featuring somatic symptoms
Study notes for Disorders featuring somatic symptoms in PSYX 340 Psychological Disorders at Montana State University: the big ideas, a worked example, common mistakes and an exam tip. The same topic has endless practice questions and flashcards in Mathub.
Big ideas
- Factitious disorder: a person fakes or induces illness to take on the sick role, with no obvious external reward (formerly Munchausen syndrome); factitious disorder imposed on another does this to someone else, often a child. Malingering is faking for an external gain (money, avoiding work) and is not a mental disorder.
- Conversion disorder (functional neurological symptom disorder): a neurological-seeming symptom (paralysis, blindness, seizures, loss of feeling) that is inconsistent with known neurological disease. Symptoms such as glove anesthesia do not follow the body’s nerve pathways.
- Somatic symptom disorder: one or more distressing bodily symptoms plus excessive thoughts, feelings or behaviors about them (usually lasting over 6 months). Illness anxiety disorder: preoccupation with having or getting a serious illness despite few or no symptoms, lasting at least 6 months.
- Explanations: psychodynamic ideas of converted conflict and primary and secondary gain; cognitive-behavioral ideas of misreading normal body sensations and rewarding illness behavior; biological findings of altered brain activity in functional disorders.
- Treatment: insight therapy, exposure and response prevention for health worry (no checking or reassurance-seeking), CBT that reframes body sensations, and suggestion or reinforcement of healthy behavior. Psychophysiological disorders (such as some ulcers, asthma or hypertension linked to stress) are real medical illnesses that stress and psychology can worsen.
Worked example
Rae visits doctors monthly because a mild headache must be a brain tumor. Tests are normal, reassurance helps only for a day, and she has felt this way for a year. Which diagnosis fits, and how does it differ from somatic symptom disorder?
Show the solution
Illness anxiety disorder. The main problem is fear of having a serious disease, with few or mild symptoms, for more than 6 months. In somatic symptom disorder the focus is on distressing symptoms themselves and excessive concern about them.
Common mistakes
- Calling malingering a disorder. It is faking for an external reward; factitious disorder is faking without one.
- Assuming conversion symptoms are faked. They are real and involuntary, though not explained by neurological disease.
- Confusing psychophysiological disorders (real bodily damage worsened by stress) with somatic symptom disorders.
Exam tipSeparate the four by two questions: is the symptom produced on purpose (factitious and malingering) or not, and is there an external reward (malingering only)?
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